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critical care > unit 4 > Flashcards

unit 4 Flashcards

1
Q

2 points to measure phlebostatic axis

at the level of the atrium

A

4th intercostal space

midaxilary line

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2
Q

causes of hypovolemic shock

A

hemmorhge
V&D
diabtes insipidus
burn victim

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3
Q

drug that helps remove potassium

A

polystyrene sulfonate

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4
Q

3 Noninvasive modalities for Hemodynamic Monitoring

A

Noninvasive blood pressure
Assessment of jugular venous pressure
Assessment of serum lactate levels

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5
Q

type of shock where

Follows invasion of a host by a microorganism

Systemic Inflammatory Response Syndrome (SIRS)
Widespread inflammatory response

A

Distributive Shock—Septic

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6
Q

3 nursing interventions for a patient witha hemodynamic monitor

A

supine position

Leveling the air fluid interface to the phlebostatic axis

infection control

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7
Q

with septic shock is lactate increased or decreased

A

Increased lactate

normal: 0.5-1 / sometimes 2

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8
Q

2 treatments for decreased contractility

A

inotrope drugs:

digoxin

dobutamine

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9
Q

cardiac output =

A

heart rate X stroke volume

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10
Q

2 Obstructive Shock interventions for PE

A

PE: thrombolytic , fibrinolytic (TPA)

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11
Q

7 Compensatory mechanisms of shock

A 
More anti diuretic hormone produced 
Increase in cortisol 
Cool extremities 
Respiratory alkalosis
oliguric (renin angiotensin aldosterone)

Hyperglycemic
Tachycardia

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12
Q

when the heart rate is too fast (SVT, AFIB, VTACH with pulse) as well as too slow (symptomatic sinus brady, blocks) can lead to _______ cardiac output

A

decreased

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13
Q

3 Obstructive Shock causes

A

PE
Cardiac tamponade
Tension pneumothorax

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14
Q

4 causes of cardiogenic causes

A

HF
Hypocalcemia
MI
Valve disease

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15
Q

device measure preload on leftt side of the heart

A

PAP

pulmonaary artery pressure

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16
Q

2 med treatment for decreased afterload

A

Vasoconstrictors (norepinephrine/levophed)

dopamine

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17
Q

3 Invasive modalities for Hemodynamic Monitoring

A

Arterial pressure monitoring

Right atrial pressure/central venous pressure monitoring

Pulmonary artery pressure monitoring

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18
Q

Normal PAOP/PAWP values are__________

wedge pressure

A

8-12 mm Hg

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19
Q

medication that increases contractility

A

dobutamine

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20
Q

4 causes of decreased preload

A

dehydration
V&D
hemmoraging
diabetes insipidus

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21
Q

5 causes of decreased contractility

A

HF
Hypocalcemia
Hypoxia

MI
Drugs (too much beta blockers)

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22
Q

with subclavian landmark for a Central venous pressure (CVP)/Right Atrial Pressure (RAP), one major risk factor is

A

pneumothorax

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23
Q

device measure preload on right side of the heart

A

central venous pressure / right artrial pressure

CVP /RAP

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24
Q

Stage of Shock where no obvious clinical signs

hypoperfusion starting

A

Initiation

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25
Q

medication that is an antihistamine

A

diphenhydramine

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26
Q

how to calculate MAP

A

systolic BP + diastolic BP x 2 /3

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27
Q

treatment for increased preload

A

diuretics

fluid volume restiction

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28
Q

lab values for AKI

A

Elevated: BUN and creatinine, magnesium, potassium & phosphorous.

Decreased: Hgb, platelets, calcium and GFR.

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29
Q

prior to insertion to verify collateral circulation in the extremity you want to do ________

A

Allen’s test

white - does not have goog circulatiion
pink- good circulation

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30
Q

2 causes of increased afterload

A

poorly controlled hypertension

pulmonary hypertension

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31
Q

treatment for increased contractility

A

Treat the cause

Beta blocker for thyroid toxicosis

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32
Q

device that measure the afterload on the right side

A

pulmonary vascular resistance

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33
Q

part of the hemodynamic pressure monitoring where you can turn this section to get blood sample

A

stopcock

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34
Q

with septic shock is platelets increased or decreased

A

Decreased platelets

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35
Q

volume of blood in ventricle prior to contraction

at the end of diastoyle

A

preload

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36
Q

type of shock where Introduction of an antigen into a sensitive individual initiating an antigen-antibody response

bronchoconstriction & vasodilation

A

Distributive Shock—Anaphylactic

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37
Q

3 nursing interventions for AKI

A

Daily weights, BUN, creatinine.

Infection prevention,

Monitoring peak and trough levels and dosage adjustments.

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38
Q

3 important components of hemodynamic pressure monitoring

A

special catheter for location
saline filled noncompliant tubing
pressure transducer

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39
Q

12 Distributive Shock—Septic clinical manifestations

A

Decreased LOC & BP
Increased HR & RR
Elevated PT & PTT
Decreased platelets

Breif CO increased then decreased
Increased WBC count 
Fever and chills
Increased lactate
Disseminated intravasculat coagulation

Warm flush skin
Bounding pulses
Hyperglycemic - early

40
Q

normal cardiac output is _____

A

4-8L/ min

41
Q

with discontinuating a Arterial Pressure Monitoring make sure to _____

A

hold pressure on site for several minutes

42
Q

Stage of Shock where – inadequate tissue perfusion unresponsive to therapy

A

Refractory

43
Q

resistance aginst flow

A

afterload

44
Q

clinical manifestations of hypovolemic shock

A 
decrease LOC 
dry mucus membranes 
tenting skin turgor 
cool clammy skin 
weak thready pulses 
tachycardia 
decrease BP
decreased urine output
45
Q

with septic shock is HR increased or decreased

A

increased

46
Q

4 Obstructive Shock clinical manifestations caused by tension pneumothorax

A

deviated trchea
absent lung sounds
asymetrical chest expansion
subq air

47
Q

treatment for obstructive shock with cardiac temponade

A

periocardiocentesis

48
Q

4 Cardiogenic Shock interventions

A

Dobutamine IV (increase contractility)

Ace inhibitor: (decrease afterload) (prill)

Diuretics: furosimide (decrease preload)

Vasodilator: nitroglycerin (decrease

49
Q

with septic shock is BP increased or decreased

A

decreased

50
Q

4 manifestations of Progressive stage of shock

A

Hypotension
Anerobic metabolism
Acidodic
Stuporus

51
Q

6 Distributive Shock—Anaphylactic clinical manifestations

A 
Urticaria (hives)
Purritus
Wheezing /stridor
Angioedema (lips and tongue swell)
Rash
Decreased BP
52
Q

3 causes of decreased afterload

A

Sepsis
Anaflaxsis
Too high med (vasodilation)

53
Q

3 Obstructive Shock clinical manifestations caused by PE

A

PE: Chest pain , Blood tinged sputum, Dypsnea

54
Q

medication that decreases preload

A

diuretics

55
Q

3 nursing intervention for Central venous pressure (CVP)/Right Atrial Pressure (RAP)

A

setting up equipment properly
sterile technique
Leveling the air fluid interface to the phlebostatic axis

56
Q

type of shock where Inadequate intravascular blood or fluid volume

A

Hypovolemic shock

57
Q

2 treatments for obstructive shock with pneumathorax

A

needle decompression, chest tube

58
Q

Invasive technique to monitor arterial blood pressure

A

Arterial Pressure Monitoring

59
Q

normal cvp measurement

A

2-6mmhg

60
Q

treatment of hypovolemic shock

A 
IV fluid
blood products (plasma)
  • warm the fluids
61
Q

Stage of Shock where – profound cardiovascular effects

A

Progressive

62
Q

force of ventricular contraction

how well the heart is pumping

A

contractillity

63
Q

with a hemodynamic pressure monitor, how much pressure should you pump up?

A

300 milimeters of pressure

64
Q

Distributive Shock—Septic cause

A

infection

65
Q

2 things needed to asses AV fistula for hemodialysis

A

fell thrill

listen for bruit

66
Q

4 clinical manifestations of decreased preload

A

decresed blood pressure
cool pale skin
tenting skin turgor
dry mucus membranes

67
Q

with septic shock is CO increased or decreased

A

Breif CO increased then decreased

68
Q

Progressive dysfunction of two or more organ systems
Can occur after any severe injury or illness
Results in maldistribution of blood flow to organs

A

Multiple Organ Dysfunction Syndrome (MODS)

69
Q

device that measure the afterload on the leftt side

A

systemic vascular resistance

70
Q

5 clinical manifestations of cardiogenic shock

A 
HF signs and symptoms 
Tachycardia
Ddcreased urine output
Weak thready pulses
BNP over 100
71
Q

4 causes of increased preload

A

HF
IV
SIADH
FVE

72
Q

amount of blood that gets ejected with every heartbeat

A

stroke volume

73
Q

with septic shock is RR increased or decreased

A

inreased

74
Q

7 Distributive Shock—Anaphylactic cause

A 
Beesting
Ace inhibitors 
Shellfish
Antibiotics
Latex

Peanut
Dyes

75
Q

3 most common site for Arterial Pressure Monitoring

A

Radial
Brachial
Femoral

76
Q

2 causes of increased contractility

A

Overstimulation of sympathetic nervous system

Too much thyroid hormone (thyroid toxicosis)

77
Q

5 clinical manifestations of decreased contractility

A 
hypotension 
decreased LOC
cool clammy skin 
weak pulses 
decreases urine output
78
Q

Shock begins with cardiovascular system failure and an alteration in one of four components:

(what can lead to shock)

A

Blood volume
Myocardial contractility
Blood flow
Vascular resistance

79
Q

type of shock where Heart fails to act as an effective pump

A

Cardiogenic Shock

80
Q

9 clinical manifestations of incresed preload

A 
Right sided heart failure symptoms:
JVD
prepherial edema
ascities 
engorges organs (hepatamegly)
left sided heart failure symptoms : 
dypsnea
crackles
decreased O2 sat 
restless 
pink frothy sputum (pulmonary edema)
81
Q

3 med treatment for incresed afterload

A

Vasodilators (nitroglycerin, nitroprusside)
Ace inhibitors
Beta blockers (metoperlol)

82
Q

treatment for decreased preload

A

IV fluids

blood products

83
Q

6 Distributive Shock—Anaphylactic treatment

A

Bronchodilators: albuterol
Airway management
Steroids: methylprednisone
Epinephrine (vasoconstrictor/bronchodilator)

Antihistamine: diphenhydramine
IV fluids / vasopressors:norepinephrine

84
Q

4 Obstructive Shock clinical manifestations caused by cardiac tamponade

A

JVD
muffled heart tones
hypotension
pulses paradoxas (BP down wtih inspiration)

85
Q

with septic shock is PT & PTT increased or decreased

A

Increased

NORMAL PTT:60 - 70 SEC
(normal PT: 11-13)

86
Q

Clinical syndrome in which there is not enough oxygen to meet the body’s demands

Impacts all body systems and can lead to organ failure and death

A

Shock

87
Q

type of shock where Physical impairment to adequate circulatory blood flow

result of trauma or complications in surgery

A

Obstructive Shock

88
Q

3 clinical manifestations of increased contractility

A

bounding pulses
headache
hypertensive

89
Q

5 Distributive Shock—Septic treatment

A 
culture 
antibiotic (broad spectrum)
fluids 
vasopressors: norepinephrine 
steroids: methylprednisone
90
Q

3 reasons for Invasive modalities for Hemodynamic Monitoring

A

Hemodynamically unstable
Extreme FVE or FVD
Major surgery (open heart)

91
Q

Stage of Shock where —compensatory mechanisms initiated

body starts kickin in to help keep person alive

A

Compensatory

92
Q

3 landmarks for Central venous pressure (CVP)/Right Atrial Pressure (RAP)

A

jugular
subclavian
femoral

93
Q

mean arterial pressure should be ____

A

> 70

94
Q

senses the backpressure of the vessel

A

pressure transducer

95
Q

3 clinical manifestions of increased afterload

A

high BP
pale cool extremities
decresed urine output

96
Q

3 clinical manifestations of decreased afterload

A

hypotensive
warm flushed skin
bounding pulses

critical care (6 decks)

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